Healthcare Provider Details

I. General information

NPI: 1144620303
Provider Name (Legal Business Name): KAISHA JUDIT TOLEDO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 DANFORTH DR
WINDERMERE FL
34786-9448
US

IV. Provider business mailing address

8833 DANFORTH DR
WINDERMERE FL
34786-9448
US

V. Phone/Fax

Practice location:
  • Phone: 787-674-8856
  • Fax:
Mailing address:
  • Phone: 787-674-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-16-18130
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: